MEDICARE: VINCENT J ORTEGA L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	4556	NM

General Provider Information

NPI Number	:	1811079635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT J ORTEGA L.M.T.

Provider Business Mailing Address
First Line	:	3492 NORTHPOINTE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3492 NORTHPOINTE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8530
Country	:	US
Telephone Number	:	505-382-1741
Fax Number	:	505-382-1741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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